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Crestwood Behavioral Health


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The Lessons of Change

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At Crestwood Center San Jose MHRC, they have been going through major changes, both physically and programmatically. The campus has undergone major reconstructive surgery, and now has a beautiful design similar to our other Crestwood programs. The design changes have brought about a more homelike environment and their clients are enjoying new areas, such as two living rooms, a comfort room, a serenity room, a group room, a library, and a den. Walls have been painted in soothing colors, lovely decor has been placed throughout the building, and new, stylish flooring has been installed.

San Jose Dining Room

Crestwood San Jose’s new design of their dining room also includes a living space that clients can also use for Xbox Connect games, karaoke, and entertainment when eating their meals.

On the program side, a mindful effort has been made to not only embrace the Crestwood Values (Family, Commitment, Compassion, Enthusiasm, Collaboration, Character, and Flexibility), but to also actively practice them in the staff’s daily activities. They have also incorporated a more comprehensive program schedule, opened up the patio area, and expanded their outing and pass policy. With these efforts, they continue to maintain the important focus on recovery, program success, and preparedness for community re-entry for their clients.

During this remodel and program changes, the staff learned some important lessons, such as any major change starts with the Administrator and Department Heads, and then it needs to be embraced by the entire team. “The change process may be challenging for some, even if it is perceived as positive or good, because it means saying goodbye to what we are familiar and comfortable with,” said Angele Suarez, the MHRC’s Program Director. Campus Administrator, Michael Bargagliotti, added, “It is human nature to be drawn to comfort and security, regardless of the outcome, because it is something that is known and we know what to expect. The change process introduces an insecurity and emotional instability that can cause people to react with resistance, fear or anger.”

To help with managing the challenges of change, the staff at Crestwood Center San Jose found that implementing a few key measures such as maintaining an open mind, being optimistic, asking questions and helping others with the changes, made a huge difference in how everyone dealt with what was happening around them.

“By maintaining an open mind, even though we may not always agree with the changes being implemented, we can actively listen and analyze the information, and then we can form an honest and genuine opinion about the changes. We might even surprise ourselves on how much we like the ideas,” said Angele.

The staff found that by being optimistic, even though people might be currently unhappy with the changes, can be helpful since negativity usually comes from a fear of the unknown. By not being able to predict the future, a good strategy is to then focus on the present moment with a positive attitude, which can create an optimistic outlook towards the future.

The staff also encouraged everyone to ask a lot of questions because it is important for each person to not only be notified of the changes that are occurring, but to also understand the reason behind the changes. Asking questions provides everyone with the needed information to make informed choices.

“And we found that one of the best ways to help ourselves with change is to focus on helping others with change. Helping others takes the focus off ourselves, allowing us to connect with our peers, and we can then become a part of the change process through positive interactions,” said Angele.

“At Crestwood, we know that we will always be part of innovative recovery practices and leadership. The best part of innovative change is that you end up creating a culture that is not only open to the concept, but takes on that personality. At Crestwood Center San Jose, as we continually work towards providing the best recovery program for our clients, going through change will allow us to continue our evolution, and never stop searching for our better self,” said Michael.

Change is inevitable in life and usually out of our control; however, how we respond to the change is completely in our control. How will you choose to change and how will you choose to respond? It is all up to you.

Contributed by:
Angele Suarez, Crestwood Center San Jose MHRC, Program Director,
Michael Bargagliotti, Crestwood Center San Jose, Campus Administrator


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The Healing Power of Dogs

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When he first stepped inside Crestwood San Diego he was thin, weak, and frightened. He had patchy hair from malnourishment and poor hygiene. He had been abused and kept in a small space when he was younger, and he was later abandoned by his first family. He had been forced to live on the streets for some time before getting taken in by the “system.” He would sometimes get aggressive with others and he clearly was traumatized by his past in ways that gave him nightmares that made him toss and turn and cry at night. His legs were weakened and arthritic from being confined when he was young, and this caused him to struggle when walking. He was nervous when he first came to Crestwood San Diego, but he was quickly embraced by both the staff and clients. His name is Gifford and he is a six-year old Chow Chow/Golden Retriever mix dog.

Gifford was adopted with another rescued older Chow Chow/Golden Retriever mix, named Enzo, from a high-kill shelter in San Bernardino by two staff members, Meghan O’Barr, a Service Coordinator at Crestwood Chula Vista and Stephen O’Barr, Director of Nursing at Crestwood San Diego.  Enzo’s first owner was a man with mental illness who ended up hospitalized for a long period of time, which then left Enzo to fend for himself on the streets, until he was picked up by the shelter.

Gifford was so scared and traumatized that he didn’t make eye contact at first, but he was ever so grateful for any petting he received. He required a lot of care, rehabilitation, and exercise before he stepped inside the facility as a therapy dog. He was shy at first, but as staff and clients opened up to him and showed him love, he quickly grew to like spending time at Crestwood San Diego and Crestwood Chula Vista. Like Gifford, Enzo had many trust issues.  He would greet people, but also kept his distance for the first month. It took patience, consistency and compassion for Enzo to get past his trust issues, just like many of our Crestwood clients.  Enzo is now the quintessential “Velcro” dog, always staying close to his family, yet with reassurance, is eager to meet new people and give them kisses.

Michael Bargagliotti, the former Administrator of both Crestwood Chula Vista and Crestwood San Diego, who is now the Administrator of the Crestwood Center San Jose campus, was highly supportive of incorporating pets as part of the therapeutic milieu.  Since September 2015, Michael opened the door to allow several staff members to bring their dogs to both facilities, including Service Coordinator, Maida Ferraes, who brings her dog Rocco; Director of Nursing Services, Fabiola Evans, who brings her dog Riley; and Service Coordinator, Jana Cook, who brings her dog Sammy Thomas. All of these dogs were rescued from shelters, have experienced their own trauma and now love their new lives as the dogs of Crestwood.

The dogs add to the feeling of a warm and homelike atmosphere that Crestwood MHRCs strive to create with a living-room milieu. They don’t just bring cuteness, fur and fun to the two programs; they have made connections with some of the clients who suffer from the worst paranoia and anxiety and who often push most people away. Studies have shown that pet therapy helps clients by lessening depression, decreasing feelings of isolation, encouraging communication, providing comfort, increasing socialization, lowering anxiety, and reducing loneliness.  Gifford recently helped a client with suspected sexual abuse to feel safe and comfortable enough so that they could start opening up to the staff. Gifford was also the mascot at the first San Diego vs Chula Vista kickball tournament, and he even makes appearances at IDT meetings so that clients can feel more comfortable in discussions that may be sometimes stressful.

One client coping with manic episodes at Crestwood Chula Vista refers to Rocco as “my boy” and their shared exuberance and energy makes them the best of friends.  Rocco has been instrumental in reducing this client’s symptoms with simple, every day dog activities, such as walks and games of fetch. Like Gifford, Rocco struggled with his relationship with other animals and underwent training with a behavioral therapist, an experience that many clients can relate to. Sammy Thomas, who one of the clients calls, “Jana’s Lamb,” is a gentle boy, who like some of our clients, suffers from a severe medical condition.  Sammy experiences seizures and takes medication daily. Jana and Meghan both use their dogs’ medication needs to help normalize medication management and this helps many of their clients realize that Sammy and Enzo are just like them.

Clients at Crestwood San Diego and Crestwood Chula Vista have watched with delight as love and care have transformed Gifford from a nervous, half-lame dog with patchy fur, into a big, friendly bear with a beautiful, thick coat. The message our clients get is that if Gifford can grow and change, then so can they.  Just as the staff is deeply satisfied by their clients’ growth and successes, the clients have taken great joy in seeing the recovery and resiliency of our Crestwood dogs and know that they are capable of recovery too. Several clients have grown very attached to the dogs and look forward to each of their visits. These amazing dogs have awakened empathy and affection in many of our clients through their unconditioned love and presence. They both share a lot of trauma and suffering in their pasts.  They also share a simple need, which is to be loved and to know that they are not alone and they can give each other that powerful, simple love that makes them both stronger and happier.  That love, togetherness, and understanding are the mainstays of recovery, and are what makes Crestwood so special.

Contributed by: Meghan O’Barr, Service Coordinator
Crestwood Chula Vista
and
Stephen O’Barr, Director of Nursing, Crestwood San Diego


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Zumba’s Spark is Energizing Crestwood

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One of the biggest challenges for both our clients and staff is finding the time and motivation to get adequate exercise. Greg Parnell, the Director of Education and Assistant Program Director at Crestwood Behavioral Health Center Eureka’s campus, has been a licensed Zumba instructor for five years now, and to say he is passionate about Zumba, would be an enormous understatement. He teaches Zumba classes not only for the clients in the Eureka facility, but also in the community at recreation centers and schools.

Zumba was started in the 1990s blending aerobic exercise with infectious Latin dance music. It is now a worldwide phenomenon being done in 180 countries, with more than 15 million students taking classes. What Greg and many others that participate in Zumba have found is that it is an activity that sparks something deep inside your spirit. That spark energizes you, changes your mood, and changes your outlook on life. Not only does Zumba bring about physical changes in you, it brings about mental and spiritual changes as well. Zumba can be a spark that starts with a simple routine of fun exercise, which then progresses into wanting to eat better, feel better, present one’s self better, and be more active in the world.

Crestwood has added Zumba to our Mind, Body, and Spirit Initiative. To get Zumba started in our facilities, Greg, along with Margaret McDonald, Administrator at Crestwood Center at Napa Valley and Crestwood’s Director of Nutritional and Wellness Services, wrote a proposal for a Crestwood Zumba Program that has several components and was geared toward both clients and staff. Their first goal was to get one or two staff members at each facility to be trained as Zumba instructors. These staff members can then teach 3 to 5 classes a week for clients and staff at their facilities. The second component was the purchase of Zumba DVDs that could be used to do additional Zumba classes or while trained staff is away. And the third part was to reach out to local Zumba instructors and develop a mutually beneficial relationship with them, in which they would volunteer their time to do Zumba at our facilities, in exchange for directing staff toward their classes in the community. Greg, as Crestwood’s in-house Zumba resource, will also travel to the facilities quarterly to reinvigorate the programs and troubleshoot any problems.

At the 2015 annual Zumba Convention that was held in Orlando, Florida, Greg shared Crestwood’s proposal for a Zumba program with Alberto Pearlman, the CEO of Zumba, who then shared it with conference Keynote speaker, actress and singer Ashley Judd, who lives her own recovery story of depression and wellness through Zumba. Ms. Judd and Mr. Pearlman were so fascinated by what Crestwood is doing with Zumba that they both decided they wanted to be involved. Mr. Pearlman graciously offered to train Crestwood staff to become licensed Zumba instructors. In November 2015, 11 Crestwood facilities, (Angwin, American River, Sacramento, Pleasant Hill, San Jose, Fresno, Bakersfield, Vallejo, Solano, San Diego, and Chula Vista) sent nineteen staff members to Cheryl Louie’s Studio Z in Newark, California, where they were trained by Joy Smith, a Zumba Education Specialist, to become licensed Zumba instructors.

Since then, Greg and Margaret have been traveling to our facilities helping our licensed Zumba instructors plan their classes, help with choreography, and incorporate classes into program schedules. “The enthusiasm from staff and clients has been overwhelming, and the support from Administrators has been amazing. It is inspiring to see how many of our clients really get into the classes, the music, the movement, and just losing themselves into the rhythms,” said Greg. “There are also stories of amazing transformations of our very quiet and soft-spoken clients who suddenly come alive when the Zumba class starts. They see and feel the energy around them and then want to join in.” And then there are also staff members, who after just one of Greg’s Zumba visits, are then inspired to want to do more, learn more, and become Zumba instructors themselves.

Greg and Margaret hope to measure the success of the program and the influence of Zumba on our clients and staff in several ways. They have developed a pre-survey to be used before Zumba is offered in the facility and a post-survey after Zumba has been added to the program schedule. These surveys will assess the number of days clients exercise, reported enjoyment of exercise, and reported barriers to exercise, such as feeling self-conscious or not enjoying exercise.

When the Zumba program is fully up and running in our Mental Health Rehabilitation Centers, Psychiatric Health Facilities, Adult Residential Facilities, and Social Rehabilitation facilities, they intend to bring Zumba Gold to our Skilled Nursing Facilities. Zumba Gold is a specialized form of Zumba for older adults. “We believe all of our clients and staff, no matter what age or ability level, will benefit physically, emotionally, and spiritually from participating in such an accessible and inspiring form of exercise,” said Margaret. “We also would love to eventually have clients be trained to become Zumba instructors, giving them meaningful roles in the facilities and the potential for employment once they are back in their communities.”

Zumba truly provides that amazing spark to energize the mind, body and spirit of those who experience and embrace it in their lives.

Contributed by:
Margaret M. McDonald, M.S.
Director of Nutrition and Wellness Services
and
Robert Pitts, Campus Administrator
Crestwood Behavioral Health Center Eureka


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Collaboration Changes Lives

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It’s unusual to observe collaboration as it is happening. It is far more common to celebrate the success of collaboration after its culminated.  Crestwood’s collaboration with San Diego Health Care Hospital system and San Diego County Behavioral Health Services has provided an incredible opportunity to observe it in real time with measurable milestones and outcomes.

This collaboration story began in 1992 when a case manager from San Diego County was seeking a placement for a very challenging client and a Crestwood facility in northern California was willing to take a chance. Later that case manager’s program manager got a chance to visit this client at the Crestwood Facility in northern California. What she saw there that day left a very positive impression that she remembered for many years to come. This was the first collaboration between Crestwood and San Diego County and set the stage for future events. Fast forward to 2013 when that very astute and dedicated program manager, Anna La Rocca Palid, LCSW, who is now a leader as a Behavioral Health Program Coordinator in San Diego County Behavioral Health Services, contacted Crestwood about the need in San Diego County for secured behavioral healthcare services. The county had grown tremendously and there were more challenging people to serve and insufficient programs to serve them. They needed a provider to work with the community and them to serve at least 40 clients requiring intensive, secured, recovery-based services. The county also wanted a provider who thinks outside the box, has creative individualized employment programs, recovery services and focuses on integrated alternative tools for clients and they chose Crestwood to be that provider.

Crestwood and San Diego County Behavioral Health Services began devising a plan to address the county’s needs. Crestwood found a beautiful site for a 42-bed Mental Health Rehabilitation Center (MHRC) on a hospital campus in San Diego and created the first of two programs – Crestwood San Diego. Crestwood San Diego opened in June 2014 and quickly filled up with 42 clients. Before long, there was a flow of individuals successfully reintegrating into the community and new admissions moving into the program. The hospitals in the area felt a sense of relief and the new services served their purpose with helping many clients with their recovery.

Soon Crestwood San Diego was full and the San Diego County behavioral healthcare system again felt the pressure of impacted Emergency Departments, long waiting lists at the psychiatric hospitals and a bottleneck in the mental health system. So they looked among themselves to find a possible location for a 40-bed MHRC. Paradise Valley Hospital found a location that would work. Crestwood and Paradise Valley Hospital started discussions about creating a 40-bed MHRC on this site. Dimitrios Alexiou, FACHE, President and CEO of The Hospital Association of San Diego and Imperial Counties and San Diego County Behavioral Health Services worked very closely together to successfully garner support from the San Diego County Board of Supervisors and the community to commit to the 40-bed MHRC in Chula Vista. Crestwood and Paradise Valley Hospital invested significantly in an extensive refurbishing project to create a beautiful, homelike, welcoming recovery-based MHRC known as Crestwood Chula Vista. Crestwood Chula Vista opened in July 2015 and is Crestwood’s ninth MHRC in California.

Collaboration is working with others to do a task and to achieve shared goals. The wonderful collaboration of these groups created an environment that enabled San Diego County Behavioral Health Services to provide beds to some of the clients in greatest need for these services, helping them with their recovery and easing stress in the community and local hospital emergency rooms. It is clear to see that through collaboration we can make a difference.

Contributed by: Patty Blum, PhD
Crestwood Vice President


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Healthy Food is Making a Difference

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The Crestwood Nutrition and Wellness Initiative was started in May of 2013 under the direction of Margaret McDonald, Crestwood’s Director of Nutritional and Wellness Services.  One of the initiative’s first goals was to provide Crestwood facilities with new menus and recipes based on government guidelines and the latest nutrition research, using whole foods, rather than processed foods.

In many of our Mental Health Recovery Centers (MHRCs), we have been able to greatly reduce or eliminate therapeutic diet orders because this diet is appropriate for the vast majority of our clients, including those with diabetes, high blood pressure, and high cholesterol.  The diet is appropriate for diabetics because we keep each meal within a certain range of carbohydrates, and we offer very few concentrated sweets.  We do most of our baking with whole wheat flour and serve real sugar in small portions. The diet is appropriate for those with high blood pressure and high cholesterol because we limit saturated fat by serving red meat only once a week and serving low-fat dairy products.  We also use very little added salt, and few processed or canned goods. Dietary Directors have reported that the costs have been about the same or a bit lower than the old diet.

We offer two fish meals per week, three vegetarian meals per week, and limit red meat to one meal a week. Other meals provide lean proteins such as turkey and chicken.  The diet is high in fiber with lots of whole grains, beans, lentils, and fresh fruits and vegetables.  We include many plant sources of healthy fats such as oils, trans fat free margarines, nuts, and seeds.  Whenever possible, we avoid products with trans fats, high fructose corn syrup, and artificial colorings and sweeteners, and we make as much as possible from scratch.  We also offer meals from a variety of cultural backgrounds in order to appeal to our diverse client population.

We have been monitoring client weights, lipid profiles, and HGBA1Cs (a measure of blood sugar levels over time).  In the facilities that have implemented our menus, we have seen a gradual weight loss in some of our overweight and obese clients, and an improvement in lipid profiles and a lowering of HGBA1Cs in some clients.  Dr. Zhongshu Yang, M.D., PhD from the University of California, Davis was so impressed with the change in weights and lab results at Crestwood Sacramento Center, that she applied for a grant to do a research project on our diet. She and a graduate student, Jennifer Papac B.S., recently presented a poster on our diet at UC Davis Medical School, titled “Crestwood Nutrition and Wellness Initiative in Long-Term Psychiatric Patients.”  They concluded that after implementing the diet, there was a reduction in the percentage of obese patients and an increase in the percentage of patients in the overweight and normal weight ranges. They also concluded that patients lost a significant amount of weight over the time period looked at, and that they showed a significant decrease in Body Mass Index (BMI) over that time period.

Lastly, we have received positive feedback from Dietary Directors, kitchen staff, and the clients themselves.  Dietary Directors’ comments include, “There was some resistance at first from clients and staff, but they gradually accepted the changes and are getting excited about eating healthy”, “We are starting to see healthy weight loss and an overall change in clients’ attitudes toward making healthier choices”,  and “Clients are enjoying the meals and we are getting positive feedback.”  Clients also have their opinions about the new diet changes and made comments such as, “It’s like restaurant food”, “I feel better and it’s only been a week”, “I feel good, not so heavy”, and “I feel like I have more energy.”

Going forward, Margaret plans to develop more nutrition and exercise-related groups, for clients, as well as health related in-services for staff.  Overall, Crestwood’s ultimate goal is to continue to improve the health and wellness of both our clients and staff through educating and serving them nutritious and delicious food that will make a difference in their recovery and lives.  In the words of Hippocrates, “Our food should be our medicine and our medicine should be our food.”

Contributed by:
Margaret McDonald, M.S.
Director of Nutritional and Wellness Services


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New Programs & Innovative Spaces

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Crestwood Behavioral Health Inc. started a big growth spurt in the spring of 2014 from Solano to San Diego. That year we opened two new distinct programs, with some exciting and significant outcomes and contributions. In April 2014, we opened our sixth Psychiatric Health Facility (PHF) at our Solano campus and in June, we opened our seventh Mental Health Rehabilitation Center (MHRC) on our first campus in San Diego. These programs are very different, but serve the same type of clients at different points in their recovery. The PHF is a soft place to land for clients who need to stabilize during a time of crisis. The MHRC is a gentle, homelike space conducive for clients to transition back into the community. The commonality between both programs is that they share the best of all of the research and practices that Crestwood has used in space conversion and intentional space utilization such as the welcoming room, comfort room, serenity room, living room, dining room and library

The welcoming rooms are dedicated to the ritual of welcoming which is based on the research and information shared by Bruce Anderson of Community Activators. It also reflects the principles of Crestwood’s First Impression program. The welcoming ritual is our way of greeting the new client when they come through our doors. This initial engagement in our welcoming room is frequently one of the most important moments in treatment. The welcoming room has comfortable furniture, fruit and snacks and a quiet, peaceful environment for the client to be welcomed into our facility. The assessment process is also part of our welcoming ritual. We use a conversation approach for the assessment and we utilize the CARF-accredited Primary Assessment that is designed to be a narrative discussion with the client. This has been an effective tool in initiating the relationship with the client, setting them at ease and garnering the most accurate and authentic information.

Crestwood’s comfort rooms provide clients with a calming place to be. We designed our comfort rooms based on extensive literature review, visits to calming and comfort rooms in New York State, attendance at conferences and interviews with experts in the field.  Our comfort rooms are used as a tool to teach individuals calming techniques in order to decrease agitation and aggressive behavior. The goal for clients in using the comfort room is to develop practical skills that can be used in inpatient settings and after being discharged from care.

Our serenity rooms are based on research from a New York State grant on Positive Alternatives to Restraint and Seclusion (PARS) and serve a dual purpose. The first is to provide a space that is calming and self-regulating for clients to be in that then reduces the likelihood of coercive treatment. The secondary purpose is to honor the spiritual growth of each client by creating a sacred space designed to support them on enriching their spiritual journey. Our serenity rooms are dedicated to support the internal growth and opportunity for contemplation, meditation and introspection.

The living rooms in our programs are designed to be an environment that is specifically for the community to congregate and visit. It is based on the promising practice in the Living Room model from Recovery Innovations. The space is less clinical and is as homelike as possible. The colors are comforting and the furnishings are aesthetically pleasing.  This room can be used for community meetings and occasionally for groups and staff interactions. It is a place where people are treated with respect, have choices and feel safe.  The other elements of the Living Room model that are in place include peer providers, Wellness Recovery Action Plan (WRAP), inclusion and comfort. This model is closely aligned with the full-array of trauma-informed care approaches that we employ.

Our library space is designed to provide another indoor space to be used by and for the clients.  This space has resources including self-help books, meditation books and books for leisure. The space is light and open at all times for clients to use.

Crestwood’s dining rooms support our wellness initiative which includes healthy heart diets and exercise. This room is also used for recreation activities, movies, arts and crafts, games and therapeutic groups.

One room that we don’t have in the programs are the restraint and seclusion rooms.  Crestwood has an initiative to eliminate the use of restraint and seclusion so we have created a trend of decreased restraints and a greater understanding and awareness of the issues surrounding their use.  In 2011, Crestwood received a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to attend the Effective Use of Peer Programs to Prevent the Use of Seclusion and Restraints Conference in Boston.  Crestwood was recognized at that training as one of the leaders nationally on reducing seclusion and restraint throughout our organization. Our level of seclusion and restraint for similar programs was one-fifth the national average according to SAMHSA consultants. Crestwood incorporates trauma-informed approaches into each program, as well as using WRAP principles and Dialectical Behavior Therapy (DBT) assumptions to create antecedent plans for clients and staff.

As a result of creating these types of innovative spaces in our programs, Crestwood has been recognized by SAMHSA for the effective use of space and the positive effect it has on each client’s outcomes. All of these spaces are designed to provide our clients with the best environment possible to support their recovery.

Contributed by: Patty Blum, PhD, Crestwood Vice President